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: Asthma testing not possible in young children
DEAR DR.PAUL: Can you please tell me when a child can be
tested for asthma? My son is just under two and is now on asthma
medication (inhaled steroids). I wanted to have him tested just
to make sure, but my doctor says that it would be hard because
he's too young.
PEDIATRICIAN DR.PAUL Answers: This is a very common
question, as parents want to make sure, and rightfully so, that
their child is not on medications unnecessarily.
Before discussing the actual asthma test, it is important to
know that most children who develop asthma do so in the first
few years of life. The diagnosis is made by the history of symptoms.
It is generally agreed that if a child has repetitive episodes
of shortness of breath, and/or wheezing and/or cough, and has
no other lung problem, the diagnosis of asthma can be made.
Testing for asthma is not that simple. The only test that can
prove the child has asthma, is the "provocation test" where
children breath in a substance known to close down the bronchi
or airway tubes. Ordinarily, at a certain dose, everyone will
react to this medication (histamine or metacholine) and their
bronchi will close down or constrict, which can be measured
by the rate at which one breathes out.
Children with asthma react to lower doses of the provoking substance.
In other words, their airways are more sensitive. This type
of test requires that a child is fully cooperative and can breath
out as hard and fast as he/she can repetitively and on demand.
In general, only children older than eight years old can undergo
this "Pulmonary Challenge", as younger children cannot perform
this test. The "challenge or provocation test" should not be
confused with the breathing tests that are performed at many
clinics and offices or even with peak flow meters.
These tests, again, only possible in school age or older children,
determine how quickly a child can breathe out - a measure of
airway blockage at that time - and are used to monitor a child's
symptoms on a daily basis. A normal test in this instance neither
confirms nor eliminates the diagnosis of asthma.
Another evaluation that parents inquire about is a chest x-ray,
which is not useful in confirming the diagnosis of asthma. A
chest x-ray is generally used, depending on the individual situation,
to make sure there are no other problems that can cause chronic
respiratory symptoms. Given that asthma testing is not possible
in the majority of young asthmatics, the diagnosis, and the
follow-up treatment and decisions to modify treatment, are based
solely on the symptoms.
This is why I always recommend keeping a daily asthma diary,
which is the best way to document a child's asthmatic symptoms
and progress. Parents should record the following: the presence
of day or night-time symptoms, dates of hospitalizations or
emergency room visits, peak flow measurements in older children,
and very importantly, the need for bronchodilator use. This
last measurement is a very good indication of the degree of
asthma control. Asthmatic children requiring less than five
broncholdilators doses per week, are usually considered to be
well controlled.
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